Botox effectively improves signs of aging to restore a more youthful and attractive facial appearance. Botox is the most popular injectable cosmetic treatment in the world. It has been used safely and effectively in reversing the visible signs of aging. As Botox not only reduces currently showing wrinkles, but also works to prevent future wrinkles it is considered to be a preventative measure as well as a corrective measure. Botox injections work by relaxing muscles to stop and prevent lines and wrinkles forming. Only specific muscles are targeted to ensure your normal facial expressions will remain unaffected. Botox takes 3-4 days to begin to work, and 7-14 days to see the full effect.
Botox treatments are priced according to number of areas being treated.
Please note: All procedures will be carried out personally by Dr Nikita Nirwan herself and prices includes a free follow up appointment..
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Dr Nikita Nirwan answers FAQ about Botox
We hope the section below answers any questions you may have about anti wrinkle treatment. If you have any further questions/concerns feel free to contact Dr Nikita Nirwan.
What is Botox?
The growing popularity of the Botox stems from its ability to temporarily reduce wrinkles on the face. In extremely low and controlled dosages, Botox effectively relaxes the target muscles, preventing them from contracting and from making the creases and wrinkles on the face. It has been used for this purpose for several decades.
More than just a treatment for wrinkles, Botox also has important medical applications. It can be used to manage or treat medical conditions such as chronic migraine, blapharospasm, idiopathic rotational cervical dystonia, strabismus, overactive bladder, cerebral palsy and Bell's palsy.
What are Botox injections made from?
The active ingredient in Botox is called botulinum toxin type A. This toxin is made by the bacteria Clostridium botulinum which is extracted using a fermentation process.
Botox also contains two inactive ingredients called human albumin and sodium chloride. Human albumin is a common protein in blood plasma which is produced by the liver. Sodium chloride is essentially salt. This is used in the dilution process so that it can be injected into the body.
How does Botox work?
A wrinkle in the skin is typically formed perpendicular to a contracting muscle located directly beneath it. For example, the muscle in the forehead is a vertical muscle, and when it contracts (such as when you raise your eyebrows), the lines that form will be horizontal.
Likewise, the two muscles that are responsible for the frown lines are positioned slightly horizontally between the eyebrows, so when they contract, the frown lines appear vertical.
Botulinum toxin for cosmetic purposes, is injected into muscles, where it blocks nerve impulses to those tissues. The muscle activity that causes the frown lines is reduced, and a smoother look results. Without a contracting muscle beneath it, the skin has a difficult time wrinkling.
Facial lines that exist when your face is totally relaxed are not very good candidates for Botulinum toxin. These lines are better handled by the dermal fillers. Botox can "soften" these lines when used over time, but not always get rid of them completely.
Normally you would see improvement within a few days. Botox requires two to four days for it to attach to the nerve ending that would normally stimulate the muscle to contract. The maximum effect usually occurs at about 10-14 days. Therefore, whatever effect is obtained two weeks after the injections should be considered the maximum effect that is going to occur.
Side effects of Botox
Potential Botox side effects include pain at the injection site, infection, inflammation, swelling, redness, bleeding and bruising. Some of these symptoms may indicate an allergic reaction; other allergy symptoms are itching, wheezing, asthma, a rash, red welts, dizziness and faintness. Below are further specific risks depending on the site treated.
Can I use Botox in lips?
Any use of Botox in the lower face is technically an off-label use (not approved to be marketed by the FDA). However, some doctors can use very small amounts of Botox to soften vertical smoker’s lines, often in combination with an injectable filler. A large dose will cause drooling and lip asymmetry and this should only be done by an experienced injector. Injections of Juvederm and Restylane are my preferred method of treating these lines, using a micro injection technique with massage right above the border of the lip which I find gives a pleasing, well defined lip without causing it to be too plumped.
Botox injections can be used around the lip area to improve the appearance of a smile that looks too “gummy.” By relaxing the muscles that pull up the upper lip on smiling and laughing, the appearance of a gummy smile can be dramatically reduced.
Can I use Botox for my gummy smile?
Botox and sometimes the addition of a filler are very helpful in correcting this problem without the risks and expense of major jaw surgery.
Botox is injected into the area next the widest point of the nose. The muscles affected are the muscles that elevate the upper lip. Since the elevation of the upper lip is relaxed, less gum shows. Sometimes, some Restylane or Juvederm can be added to the upper lip which would further erase the appearance of a gummy smile.
Botox effects around the mouth can be of a shorter duration, which can be dose-related, and also has to do with how much motion, function and blood flow there is in the muscles of the lip.
Can I use Botox to treat bunny lines?
Along the upper third of the the nose, some people develop facial lines commonly called ‘bunny lines’. Bunny lines are often an issue to many people. It is caused by the hyperactivity of the nasalis muscles when laughing or smiling. They are called bunny lines since they’re developed from the twitching of the nose muscles.
You can see bunny lines by scrunching your nose. These facial lines may be diagonal, vertical or horizontal. I usually treat bunny lines with a tiny dose of Botox placed in either side of the nose, relaxing this area and giving a nice smooth appearance to the nose.
It is important not to inject too lateral or away from the nose to avoid affecting the patient’s smile. Though only a little dose of Botox are administered to treat bunny lines, it will require regular treatments as soon as they start to reappear.
Botox for crow’s feet
Botox has been safely and effectively used in this area for many decades with pleasing results. There are very few risks when conducted by a safe practitioner and can knock years off of your smile.
Small concentrated doses into the orbicularis oculi (the muscle encompassing the eye socket) are needed to effectively block the action of the muscles around the eyes that cause excessive wrinkling of the skin on smiling broadly.
Botox for crow's feet risk
You can be confident that you are at almost no risk for eyelid droop if you are only having your crows’ feet injected. Actually, by injecting the superior aspect of the muscle that causes crow’s feet, you can gain a slight lift to the outside eye area. This is a relatively low risk site for injection and hence a good starting point for anyone wanting to try out Botox for the first time.
Botox for forehead lines
As you raise your eyebrows the vertical muscle in the forehead (frontalis muscle) activates and it is because of this activity that horizontal skin creases are seen. These creases can be classified as dynamic lines; ie, present when making certain facial expressions, or static; ie, present all of the time even at rest. Formation of static lines can be of concern, making your skin look aged. By placing botox in certain areas of the forehead, you can inactive the frontalis muscle so to get relaxation of the muscle and hence within a few weeks, softening of these lines. Over continued use of botox in this area the lines can fade away completely, giving a refreshed appearance. Some lines can be deeply ingrained, hence consideration to other skin tightening treatments must be given.
Botox for vertical forehead, or the ‘II’ lines
This is the most common area of treatment with botox and the area for which Botox is approved for use by the FDA. Botox is very effective for lines between the eyebrows. As a neuromodulator it works directly to relax the nerves that innervate the corrugator and procerus muscles of the glabella region (i.e., the vertical and horizontal lines that form between the eye brows). Since this area has lines caused not by gravity but because of movement of facial muscles rather, they are more amenable to be removed by the use of botox. Dermal fillers can be used here also, delicately, but most of my patients will see a substantial, if not a complete resolution of these lines if this muscle is regularly inactivated.
Botox for forehead line risks
There are 2 rare, but possible complications of botox in the forehead area:
- A drooping eyebrow may happen when the brow-elevating muscle in the forehead, the Frontalis, receives too high a dose of Botox, or alternatively, if the Botox is sub-optimally placed too low in the forehead. Of note, it may also happen if you have a low set eyebrow to begin with, in which case any Botox to the Frontalis increases the likelihood of a brow droop. A droopy eyebrow from Botox can sometimes be improved with Botox injected into the outside part of the eye (the lateral aspect of the orbicularis oculi muscle) to generate a bit of a brow lift in that area -- by injecting more Botox and paralyzing the orbicularis muscle that normally acts to depress the brow in that area, you may get a slight compensatory brow lift.
- A droopy eyelid may occur if the Botox is injected too close to your eyelid-elevating muscle, the levator palpebra superioris. In such a scenario, the Botox will diffuse inadvertently onto the levator muscle and cause an eyelid droop. You may have an increased risk of eyelid drooping if you have a weakened upper eyelid muscle for neurological reasons, or a deeply set eyebrow that would be more prone to drooping (as discussed above) and result in skin gathering over the eyelid making the eyelid appear like it was drooping. A droopy eyelid due to Botox can be treated with Apraclonidine eye-drops which can provide a small improvement.
I think the key with Botox lies in truly understanding the anatomy of the injected area, and more importantly the variability in the anatomy between patients -- for brows, the forehead, and anywhere else you plan on receiving a Botox injection. This includes having a firm understanding of the origin, insertion, and action of each muscle that will be injected, the thickness of each muscle targeted, and the patient variability therein.
Botox for eyebrow lifts
We can lift the brows by weakening the muscles that pull down on the brow.
There are three depressors of the eyebrows:
1) Procerus (muscle the pulls down on the brows, creating a horizontal crease at the top of the nose
2) Corrugators (muscles that pull the brows inward and downward, creating the 11 lines)
3) Obicularis oculi (muscle that encircles the eye, allowing it to close tightly)
Botox used into these muscle sites will effectively relax these muscles and control their contractions, giving a smooth skin appearance even when frowning.
Interestingly, several research articles have found that as well as your brain controlling the emotions that you express on your face, it works the other way round too- your facial expressions can make you feel a certain way. By forcing yourself to smile, you may find that you actually start to feel happier, and in the same way, by reducing your ability to frown you may find yourself feeling less stressed!
Botox for eyelid lines
Botox is not the best product for reducing the lower eyelid lines. This is because the muscles that are making those lines are also supporting the lower eyelid. When sufficient botox is used to improve the lower eyelid lines, there can be a weakening of this muscle which can cause the lower eyelid to fall. This weakness of the lower eyelid can be bothersome. A great alternative is to fill the lines with Restylane. This product lasts much longer than the botox so it is a great choice.